Taiwan has recorded its first dengue fever death in this year, following a week in which domestic cases climbed by 206 to 630, the Centers for Disease Control (CDC) said.
A woman in her 40s from Tainan died on July 21 after being hospitalized with dengue fever, marking the first fatality of Taiwan’s worst outbreak of the mosquito-borne disease in a decade.
A single dengue fever case can be linked to three or four other people who do not have detectable clinical symptoms. As it is summer holiday, a high season for traveling, sporadic cases could turn into clusters or outbreaks in communities, which increases the risk of transmission in urban areas.
Dengue infections are caused by mosquitoes carrying one of the four closely related viruses: DENV-1 to 4. These four viruses are called serotypes because each interacts differently with the antibodies in human serum. Common factors associated with dengue infection include society, population, insects and environment, as well as temperature and rainfall.
As disease-carrying mosquitoes only fly limited distances, it is the mobility of people that has facilitated the spread of the disease. As dengue hotspots are in southern Taiwan, such as the Rende (仁德) and Yongkang (永康) districts in Tainan, officials must account for potential change factors such as mobility, living environment, mosquito density in each district based on population and the weekly weather, to model possible dengue outbreaks in nearby neighborhoods.
The CDC needs to put forward the best preventive measures. If failure occurs the CDC also needs to determine whether it is caused by management strategies or ineffective measures.
The only measure currently used to control the disease is to suppress or eliminate mosquito populations. The direct method is to use insecticide spraying or make use of natural predators against mosquitoes. The indirect method is to have the public take urgent action to reduce mosquito breeding habitats by keeping their living environment clean and free of containers with stagnant water.
A new mosquito control strategy based on genetically manipulating mosquitoes is still being developed, but humans need to bear in mind the technology’s ethical implications and its impact on the ecosystem. Using fish and crustaceans to feed on mosquito larvae could take a bite out of mosquito populations, but the proposal has not yet been tested in communities.
As Aedes aegypti mosquitoes usually feed and live indoors, installing screens for doors and windows can prevent them from flying in. The public sector should encourage and subsidize the installation of screens in people’s houses.
The government should educate residents of neighborhoods hit by dengue fever on how to fight the disease and share the responsibility. In this way, it should be easier to introduce interference measures such as clearing waste, insecticide spraying and adopting ovitraps. As single measures cannot stamp out dengue fever, overall environmental management of neighborhoods and combined interference measures should yield superior results. Dengue fever prevention requires cooperation across sectors, where resources should be aimed at curbing the outbreak, not just reducing mosquito populations, as it does not necessarily prevent dengue fever outbreaks.
Furthermore, the anti-dengue campaign requires talented people with a public health background who have suitable knowledge of prevention and prediction measures. Without making such an investment, fighting dengue fever is an uphill battle
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Wong Ruey-hong is a professor at Chung Shan Medical University’s School of Public Health.
Translated by Rita Wang
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